Provider Demographics
NPI:1295885838
Name:MCMILLEN, LILIANA J (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LILIANA
Middle Name:J
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:J
Other - Last Name:BEJARANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2238 E GINTER RD
Mailing Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-5806
Mailing Address - Country:US
Mailing Address - Phone:520-545-2137
Mailing Address - Fax:520-545-2120
Practice Address - Street 1:2238 E GINTER RD
Practice Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5806
Practice Address - Country:US
Practice Address - Phone:520-545-2137
Practice Address - Fax:520-545-2120
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138847Medicaid
AZ138847Medicaid